Fraud Audit & Investigations Analyst

Public Partnerships | PPL

. Conduct and/or support investigations into suspected fraud, waste, abuse, neglect, and exploitation .

Posted 10/7/2026full-timeRemote • United StatesMid-LevelSenior💰 $77,500 - $99,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in investigating and auditing fraud, waste, and abuse within Medicaid and healthcare settings, with a strong focus on compliance, documentation, and regulatory requirements. Capable of managing multiple investigations and audits while maintaining high standards of quality and organization.

Highest-signal resume keywords

Fraud InvestigationsMedicaid Program RequirementsRegulatory ComplianceDocumentation SkillsAudit Preparation

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Investigative StandardsData AnalysisQuality Control ReviewsProcess ImprovementDocumentation StandardsCase SummariesRFI Response PreparationAudit ProtocolsRisk AssessmentCompliance Auditing

Soft Skills

Organizational SkillsWritten CommunicationJudgment and DiscretionCollaborationTime Management

Certifications & Qualifications

CFEAHFICCEP

Industry Keywords

MedicaidLHCSAMCOHealth Plan ComplianceProgram IntegrityConsumer-Directed CareCDPAPRegulatory AuditsSOPsExternal Stakeholders

About the role

Key responsibilities & impact

Conduct and/or support investigations into suspected fraud, waste, abuse, neglect, and exploitation
Interview witnesses, gather and preserve evidence, and document findings according to investigative standards and chain-of-custody practices
Assess provider, consumer, and caregiver conduct against program requirements, including CDPAP attestations, relationship restrictions, and EVV compliance
Partner with analytics to validate and develop data-driven leads into case-ready findings
Prepare case summaries, findings, and referral recommendations
Perform quality-control reviews of case files, referrals, and investigative documentation
Audit adherence to investigative protocols, SOPs, and documentation standards
Analyze documentation and operational processes to assess compliance, identify risks, and propose process improvements
Identify and remediate documentation gaps before internal sign-off or external submission
Support internal audit-readiness reviews of the Program Integrity function
Compile, organize, and quality-check RFI response packages for MFCUs, OMIG, health plans, and other regulators or auditors
Track RFI deliverables, timelines, status, owners, and deadlines
Coordinate with Legal, Compliance, Risk & Assurance, and Operations to gather documentation and data
Support external audits and assessment requests
Partner with MCO/health plan SIU and compliance counterparts on shared investigations and referral processes
Support relationships with regulators, MFCUs, and law enforcement partners
Provide frontline and health plan perspective when designing or refining investigative and audit processes
Perform other duties as assigned

Requirements

What you’ll need

Demonstrated experience investigating and/or auditing fraud, waste, and abuse in a Medicaid or healthcare setting
Familiarity with LHCSA agency operations, MCO/health plan compliance or SIU functions, and state or federal regulator expectations
Working knowledge of Medicaid program requirements, including consumer-directed care programs such as CDPAP
Excellent organizational and documentation skills
Ability to manage multiple investigations, audits, and RFIs simultaneously under deadline pressure
Strong written communication skills and ability to produce clear, defensible, and professional case and audit documentation
Sound judgment and discretion when handling sensitive or confidential information
Comfortable partnering across compliance, legal, operations, and external stakeholders
Bachelor's degree preferred; substantial professional experience may be considered in lieu of a formal degree
5–7 years of combined experience across LHCSA, MCO/health plan, and/or state regulatory Medicaid roles
Prior experience in fraud investigations, program integrity, or compliance auditing required
Experience preparing or responding to regulatory RFIs, audits, or CAP documentation preferred
Experience with consumer-directed care programs such as CDPAP strongly preferred
CFE, AHFI, or CCEP preferred but not required

Benefits

Comp & perks

Remote work with occasional business travel